<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        
        <div class="layui-form-item">
            <label class="layui-form-label">卡号</label>
            <div class="layui-input-block">
                <input type="text"  class="layui-input" disabled="" value="{$row.payee_bankno|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">开户行</label>
            <div class="layui-input-block">
                <input type="text" class="layui-input" disabled="" value="{$row.payee_bankname|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">收款人</label>
            <div class="layui-input-block">
                <input type="text" class="layui-input" disabled="" value="{$row.payee_name|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">手机号</label>
            <div class="layui-input-block">
                <input type="text" class="layui-input" disabled="" value="{$row.phone|default=''}">
            </div>
        </div>
         <div class="layui-form-item">
            <label class="layui-form-label">申请金额</label>
            <div class="layui-input-block">
                <input type="text" name="amount" readonly="" class="layui-input" value="{$row.amount|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">提现前总收入</label>
            <div class="layui-input-block">
                <input type="text" class="layui-input" disabled="" value="{$row.before_total_income|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">提现前剩余可提现收益</label>
            <div class="layui-input-block">
                <input type="text" class="layui-input" disabled="" value="{$row.before_availble_income|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">状态</label>
            <div class="layui-input-block">
                <input type="radio" name="state" value="1" title="审核通过" {eq name="row.state" value="1"}checked=""{/eq} >
                <input type="radio" name="state" value="-1" title="驳回" {eq name="row.state" value="0"}checked=""{/eq}>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">审核结果描述</label>
            <div class="layui-input-block">
                <input type="text" name="msg" class="layui-input" lay-verify="required" placeholder="请输入审核结果描述" value="{$row.msg|default=''}">
            </div>
        </div>
        
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>